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r Form-�nprovedC>MBNo..2050-0039.{Expi 930-.9Y1 :i,"ks ui:-e, ._ Cti Iflailus ktu sl' y,arse ►nr.w_.v. �....a,. �r.y. Wopm:mWrai oJu .�pstoncoss,pn <br /> Pleats.' nl i.r ..•ti ores deli nsd faryse an rhle f2 i -�ewnfar �' '�"i'. � _ <br /> . ORlwl FIAZARDOLIS noraror,usl Pa>DrNa r Manifest ' * P�pogd7 .�„ ;Itslfie '� <br /> v <br /> " �. <br /> WASTE MANIFEST "]31' ► � CI <br /> 3.GeneraFoes Name and Mailing <br /> Address <br /> _ <br /> �.t�•A L��'II�taMllslJ.lJi7 iKapJwii1'i } �• IMN <br /> ' ' `2f �� �.11111A r �t.0�3 .QA F CA 9521 $. s . <br /> A. Generator's Phone(209 <br /> N 5. Transporter 1 Company Name �.,, y 6. US EPA ID Number C Ssala�ronspos7era 1O) ' <br /> ctt •,,u;'••144 �' "�.a s�w+� a 37i.r h 4La�a..yL rtbem C a.1i-il ni,' aP'.�`.#{�it. —•.r1�}d <br /> d k;,j0ja*d:Lca.L �.#1�L rt�'�°�.,r3.Z4 3�<f i gj i# D Transparler+3�feane r ,i?�V" " 4vg j' ri• <br /> r <br /> W 7. Transporter 2 Company Name 8. US EPA ID Number E SraN Transporters ID Ko;ieryed j <br /> .fix <br /> F Trarnsportert Phone <br /> 3o V 9. Designated facility Name and Site Address 10. US EPA ID Number G State Facility's ID <br /> r, lik ID PAP] <br /> .. _ 10103 . 9 <br /> + <br /> F.a t ■ r <br /> j7t.; r#t Street4 {neiliya t ha w, <br /> °_ &aari,• xt•' rA � �q g L' g 3 5 £► a -- i1$ <br /> 12. Containers 13. Total 14.:Unit e <br /> Q 1 3. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> �V No. T Quantity Wi/Vol l WaslelJtxtstaer: <br /> RQ . Hazardous Viabt e, Liquid, N.O. S. <br /> NA 'IOR1 , F6 TI?, ("3i Ivor) -t+.Alafrer <br /> G ru+ <br /> co E EPAJC>lliar',E'� <br /> GOO EPIClOtI s ;i <br /> $t .yr'.::'IAS Y•eSr.1�1s.W� <br /> Z <br /> Uj <br /> ZJ. Additional Descriptions for Materials listed Abort K Hon0ing Codes for Was Lsted Aha 1 ry <br /> 1l Spent fl !x 4021taisd lq .f;Uv*2' <br /> Z 15. Special Handling Instructions and Add tior al In6nnolion _ r �.LAND V v--........� +& $16 4l K)NNQ 1 1. <br /> O <br /> Wow prow prates tive lQU f11lTIt.!ODvwx L good* } Pastrk-tod Coratituth ;DOI lf.AaI , <br /> Z DOT >�= �7 Tf!'it �yi'dT1�tt : ,n <br /> sit �rt�,�gMs�cyotyrt+eta[. fsC+1t-4E4-v3�)G Siv+eri,owalrx: 1300• 5Wj PPM <br /> 16, GEHER mrs CERTIFICATION:. 1 hereby declare Thai the contents of this consignment are fully and occvrotely described above by proper shipping name and are classified,pa&od,.' . <br /> marked,and labeled,and are in all raspech roer in ppcondition for transport by highway=ording to applicable internationol and national government regulations. <br /> Ff I am a large goantify Renero ar,1 certify 16W I bay.a in plan to reduce the volume and toxicity of waste generatecl to the degree I have do tenninsd to be eeoiareico . <br /> a prosicable and that 1 ha.e selecMd des��6*iedrod IreaMnent,storage,or disposal curmnify available to me which minimizes the present and futvrs threat to human health <br /> and dse err.iroerrsrst;OR,9 1 are a srna/Qw"y yewsb.1 low"mode o good faith effort so minimize my woos generation and select the best waste management medwd Owt is <br /> K eveik"to me and dsat I can offord <br /> O <br /> V6 M <br /> Z <br /> i 17. i i OF J roti <br /> f - a..� <br /> as. 1 18. Imuponot 2 1114 .+..�_1 <br /> O T Mnted/Typed Nome Signature Month Day Year <br /> LU E <br /> U) t <br /> 19. Discrepancy Indication Space <br /> z f <br /> A <br /> C <br /> L <br /> 1 20. Fe"ify Owner er Oporoky Certiiicariwr of receipt of heaordars esoser:als covered 6Y this WA i6%1 oxc!W1os1,taVcl in 14A 19. <br /> T Printed/Typed Name I SigKA" Month Dc7 Year <br /> Y <br /> `Po NOT WRRE IkLOW THIS LINE. <br /> DTSC;8022q,(1/99) Green. ,tPANSPORTER RETAINS' . <br /> EPA 8700=22 <br />